Download PDF
J Reconstr Microsurg 2014; 30(01): 021-024
DOI: 10.1055/s-0033-1348899
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Digital Neural Loops: Classification and Implications of Variation in Hand Surgery

Vachara Niumsawatt
1   Department of Plastic and Reconstructive Surgery, The Northern Hospital, Epping, Victoria, Australia
,
Warren Matthew Rozen
1   Department of Plastic and Reconstructive Surgery, The Northern Hospital, Epping, Victoria, Australia
2   Department of Surgery, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
› Author Affiliations
Further Information

Publication History

16 January 2013

17 May 2013

Publication Date:
19 June 2013 (online)

    Permissions and Reprints

Abstract

Background The “neural loop” describes a digital artery passing through a digital nerve, after which both the structures progress distally to supply the digit. While rare, past descriptions refer to neural loops located around the common palmar digital arteries, with no reports of more distal loops.

Methods We describe a case in which a distal neural loop was identified, with the ulnar proper palmar digital nerve (PPDN) to the long finger split, and reconstituted around the radial proper palmar digital artery (PPDA) to the ring finger. This variation was explored within the previously reported classification systems for such neural loops in the literature.

Results Previously reported neural loops have been localized to the palm, without report of formation of a neural loop by the penetration of a PPDA. A new classification of neural loops is presented in this context on the basis of anatomical location.

Conclusion This new model, of separating neural loop position into anatomical levels, provides more information to the hand surgeon when dissecting and raising vascular pedicles for flaps reconstruction.

Keywords

hand surgery - digital vessel - digital nerve - artery - nerve
 

  • References

  • 1 Hartmann H. Note sur l'anatomie des nerfs de la paume de la main. Bull Mem Soc Anat Paris 1887; 62: 860-864
    PubMedGoogle Scholar
  • 2 Gotani H, Gilbert A. Hartmann's boutonnière: an anatomical study of digital neural loop penetrations in the palm. J Hand Surg [Br] 1999; 24 (1) 35-37
    PubMedGoogle Scholar
  • 3 Lee JY, Kim YR, Kim JN, Choi HG, Song WC, Koh KS. Penetration of the digital nerves by the common palmar digital arteries in human cadavers. J Hand Surg Am 2010; 35 (12) 2022-2026
    CrossrefPubMedGoogle Scholar
  • 4 Bas H, Kleinert JM. Anatomic variations in sensory innervation of the hand and digits. J Hand Surg Am 1999; 24 (6) 1171-1184
    CrossrefPubMedGoogle Scholar
  • 5 Spinner RJ, Varela CD, Urbaniak JR. Digital nerve penetration by a digital artery in a patient with neurovascular symptoms: a case report. J Hand Surg Am 1996; 21 (6) 1101-1103
    CrossrefPubMedGoogle Scholar
  • 6 Vathasala V, Ratnasamy S, Kalpana S. Digital neural loop – a rare anatomic variation. J Anat Soc India 2008; 57: 155-157
    PubMedGoogle Scholar
  • 7 Lanz U. Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg Am 1977; 2 (1) 44-53
    CrossrefPubMedGoogle Scholar
  • 8 Wallace WA, Coupland RE. Variations in the nerves of the thumb and index finger. J Bone Joint Surg Br 1975; 57 (4) 491-494
    PubMedGoogle Scholar
  • 9 Miller RA. Observations upon the arrangement of the axillary artery and brachial plexus. Am J Anat 1939; 64 (1) 143-163
    CrossrefPubMedGoogle Scholar
  • 10 Denkler K, Norman MA. Nerve and arterial supply to the hand in Vesalius's De Humani Corporis Fabrica. Hand 2012; 7 (2) 224-228
    CrossrefPubMedGoogle Scholar